šCroghan Meat Market, Inc.›

Croghan Bologna™ Mail Order Form

Send a taste of the true North Country…

Please Print this page, Fill out the form below and mail it to:

Croghan Meat Market, Inc.

PO Box 87

Croghan, New York, 13327

Or call and place your order at:

1 (315) 346-6613

Checking the Box(es) to select your products:

NOTE: Price includes priority postal shipping. A ring of Bologna ranges from 1lb. to 1.25lbs - so consider how many rings of bologna you want and that will equal the poundage you require.

Ex. 10 pounds (lbs) = 10 Rings at 1lb a piece or 8 rings at 1.25lbs a piece.

· You can substitute cheese or our famous Croghan Smoked Breakfast Links at the same price per pound! However, since we are a USDA inspected plant we cannot ship cheese curd – if you call we can direct you to mail order facilities that do send cheese curd via mail.

o Please make note below how many pounds you want substituted and what you want it substituted with!

Regular Gift Packages……………Total Pkgs.	Bulk Box Gift Packages………………Total Pkgs.
¨ 2lbs Croghan Bologna.......$30.00…...… _____	Reminder: These include UPS Shipping!
	Please include a Street Address for delivery; no PO Boxes please!
¨ 3 lbs Croghan Bologna........$39.00…….. _____	¨ 10 lb. bulk box........$ 100.00…………… _____
¨ 4 lbs Croghan Bologna.........$48.00.....… _____	¨ 15 lb. bulk box.........$ 125.00………….. _____
¨ 5 lbs Croghan Bologna........$57.00….… _____	¨ 20 lb. bulk box..........$ 165.00………….. _____
¨ 6 lbs Croghan Bologna..........$65.00..… _____	¨ 25 lb. bulk box...........$ 200.00 ………… _____

Check any substitution(s): ¨ Mild ¨ Medium ¨ Sharp ¨ X-Sharp

Flavored cheese: ¨ Horseradish or ¨ Smoked Cheese-8oz.

¨ Smoked Sausage: ___________ (lbs)

¨ Maple Syrup (Call for availability and pricing) - 1 pint ONLY

Notes:

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TOTAL : $__________________________________

PAYMENT: Please pay by check or money order made out to Croghan Meat Market, Inc.

There is a $25.00 return check fee. *Prices are effective 11/08, are subject to change.

We also accept VISA or MC!

Card Type (Check Box): ¨ Visa or ¨ Master Card

Card#: ___________-___________-___________-___________

Expiration Date: ________________

3 Digit Security #:__________ * This is usually the last three numbers located on back of most Cards.

Sent By/Card Holder’s

Name (as it appears on the card):_______________________________________________

Phone # :(______) ________-___________

Street Address: _________________________________

_________________________________

CITY: _____________________ STATE: ____________ ZIP:___________

Ship to Address

· If you are sending multiple packages: Please list the addresses on the back of this form or on a separate sheet of paper with the amount to be shipped to that address and what any gift messages you want included to say.

NAME: _____________________________________________

ADDRESS: ____________________________ APT#:_________

CITY: _____________________STATE:____________ZIP:___________

Check here to add a free gift message to the package!

¨ GIFT MESSAGE TO SAY: _______________________________________

_______________________________________

_______________________________________

Check box for when you want this order shipped:

We ship only during the beginning of the week to ensure freshness!

¨ NOW

¨ THANKSGIVING

¨ CHRISTMAS (Submit by December 12^th, 2008 to ensure it is received by Christmas!)

¨ OTHER (Specify date): _______________________